CPT CODE 87880, 87561

CPT CODE and description

87880 - Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A  - average fee amount - $20 - $30

87561 - Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique


Coding for Reflex Testing

Some clinicians may desire to use both rapid immunoassay and molecular Strep A testing methods in a reflex testing scheme. This scheme is analogous to reflexing a rapid immunoassay to culture in which the molecular test is used in place of culture. For example, the initial test might be performed with a rapid immunoassay and then reflexed to molecular if the immunoassay results are negative but clinical signs suggest Strep A infection.

While the codes described above apply separately to these different testing technologies, both are Strep A tests. There is a Correct Coding Initiative (CCI) edit for CPT® 87880 and 87651. This CCI edit CANNOT be overcome by a modifier. Therefore, for Medicare and any other payer that utilizes CCI edits, billing for both tests of this reflex testing scheme is not permitted.

Coding for CPT® 87880 and 87651 may be permitted by some non-Medicare payers if they do not utilize CCI edits. Providers should contact non-Medicare payers to determine whether billing for both CPT® 87880 and 87651 is permitted.

Note that ordering clinicians must be aware of any reflex testing policy by a laboratory and should only order reflex testing if medically reasonable and necessary


Coding Summary

Test             CLIA         Payer           CPT® Coding

Rapid Immunoassay

Acceava®, BinaxNOW®, or Clearview® brands or other Strep A tests manufactured by Alere

Waived Medicare 87880QW

Waived Non-Medicare 87880


Amerigroup Reminder: We Cover Rapid Strep Tests

Reminder: Rapid strep tests billed with CPT code 87880 are covered. This test should be completed for any child prescribed an antibiotic for pharyngitis

What this means to you: For your information only. No immediate action is  necessary



Background

As part of our annual Healthcare Effectiveness Data and Information Set (HEDIS) audit, we assess appropriate testing for children with pharyngitis. The Centers for Disease Control and Prevention and the National Committee for Quality Assurance guidelines constitute the basis for this HEDIS measure.

As part of our audit, we review members’ medical records, claims and laboratory data.

 During our last audit, many of you said Amerigroup Community Care does not reimburse for rapid strep tests; therefore, you don’t file claims for this service. 

We want you to know Amerigroup does cover the rapid strep test when you file a claim using CPT code 87880. Pharyngitis can be validated through lab results; therefore, it serves as an indicator of appropriate antibiotic use. Attached is a summary sheet for this measure and the appropriate codes to use for diagnosis and payment.

We know many parents and guardians request or insist on antibiotics when they aren’t necessary for treatment. We count on your excellent training and cooperation to comply with this standard for appropriate antibiotic use.


Billing example

Mrs. x’ Visit

• Physician Visit – CPT 99202

• Nursing Work – CPT – (Office)

• Rapid Strep – CPT 87880

• All Linked to ICD-9 Code 462 (Pharyngitis)


Payments

• Medicare Pays $36.8729 per RVU

– 1.73 RVUs X 36.8729 = $63.790117

– Rapid Step (CPT 87880) = $16.01

• Total Payment From Medicare = $79.80

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